Provider Demographics
NPI:1689293631
Name:NAGAR, CHETAN
Entity Type:Individual
Prefix:
First Name:CHETAN
Middle Name:
Last Name:NAGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 ROLLINGSFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3862
Mailing Address - Country:US
Mailing Address - Phone:941-350-7331
Mailing Address - Fax:
Practice Address - Street 1:2700 RECKER HWY
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1901
Practice Address - Country:US
Practice Address - Phone:863-291-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031898183500000X
FLPS56158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist